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Feldman discusses the importance of self-education and open communication between patient and physician to help stay informed about relevant laws.
In the final part of a 3-part interview series with HCPLive, Madelaine Feldman, MD, advises patients on how to educate and advocate for themselves regarding medication access in their state.
“I would strongly encourage patients to urge their physicians to appeal any drug denials, especially those related to prior authorizations,” Feldman said. “Physician appeals, coupled with demands for peer-to-peer discussions, often result in the reversal of these denials. Unfortunately, we've observed a recent trend where insurance companies employ artificial intelligence (AI) to expedite prior authorization denials, which has led to a surge in initial denials for certain medications.”
Additionally, Feldman mentioned the “map tool” available Coalition of State Rheumatology Organization (CSRO)’s website which allows patients to better understand the laws regarding medication access in their state. With this tool, a patient can determine whether their state has passed step therapy reform, banned copay accumulators, or prohibited non-medical switching.
If such laws do exist in their state, Feldman advises bringing them to their physician's attention.
“It's important to note that while many beneficial laws have been passed across the country, most physicians remain unaware of them,” she said. “Numerous advocacy groups, including the Alliance for Patient Access and CSRO, are working to raise awareness about these patient-supportive laws, but it's been challenging.”
Feldman emphasized self-education and open communication with a physician to help stay informed about relevant laws. As federal laws progress, it's crucial to bring media attention to these patient-protecting regulations. In doing so, she explained, physicians can empower patients with knowledge about these laws and foster a collective effort to address these challenges.
Luckily, it appears regulatory bodies and government agencies are increasingly recognizing the wellbeing of patients in the United States should take precedence over the interests of shareholders in publicly traded health insurance companies.
“The ongoing work on regulations and legislation holds the promise of a brighter future for healthcare accessibility and affordability in the country,” Feldman concluded. “Although it may take time, I am optimistic about the progress we have made and the positive changes we can achieve.”
This article was edited for clarity.
Feldman is president of the Coalition of State Rheumatology Organizations, chair of the Alliance for Safe Biologic Medicines, and a member of the Alliance for Patient Access.